“The idea of a psychotherapeutically informed psychiatry seems such a simple and obvious one and yet the divide between psychotherapy and general psychiatry – between ‘brainlessness’ and ‘mindlessness’ has, until recently, seemed unbridgeable”.

The Psychotherapy section of the Royal College of Psychiatrists has the largest membership in the college. Since psychotherapy became recognised as a discipline within psychiatry in 1975 the Royal College of Psychiatrists has recommended one consultant psychotherapist for each 200,000 of the population. In Northern Ireland there are only 1.9 whole time equivalents rather than the eight expected and in the Republic of Ireland there is none. According to the recent document produced by the Royal College of Psychiatrists' Psychotherapy Faculty Executive Committee in December 1998, The development of psychological therapy services: Role of the consultant psychotherapist, there has been no net growth in the last five years in the numbers of psychotherapists in England and Wales. The future looks equally gloomy in Ireland.

This is rather surprising given that recent government documents have highlighted both the importance and the effectiveness of psychological therapies. There is a growing evidence base underpinning the use of psychotherapy in the management of a wide variety of conditions including psychoses, eating disorders and severe personality disorders.

Psychotherapy has high public acceptability and finds itself in the unusual position of having both government and public demanding the provision of extra psychological therapies, but not receiving the full support of psychiatry and the purchasers of healthcare.

Objectives: To evaluate the sensitivity of the CAMCOG naming subscale to anomia in Alzheimer's disease (AD) patients identified as anomic on the Boston Naming Test (BNT); and to compare the sensitivities of BNT, category (semantic) fluency (CF), and episodic memory (Delayed Word Recall, DWR) in detecting AD.

Method: Data from 140 probable AD patients (NINCDS/ADRDA) were analysed. Anomic AD patients were identified (BNT) and the sensitivity to anomia of the CAMCOG naming subscale was calculated. Sensitivity (to AD) and specificity of the BNT, CF and DWR were compared in a subgroup of 60 patients age-matched to controls.

Results: On BNT 81% of ADs were classified as anomic (87% specificity). Of these anomic ADs, 23 scored 6/6 on CAMCOG naming (sensitivity = 80%), and sensitivity fell to 30% using a 5/6 cut-off. Correlation between BNT and CAMCOG naming yielded Kendall's tau = 0.48 (p<0.0001). Compared to age-matched controls BNT correctly classified 70% of ADs and 87% of controls (overall accuracy = 77%). On CF 68% of ADs and 83% of controls were correctly classified (overall accuracy = 72%). BNT and CF were moderately correlated (r = 0.49, p<0.0001). DWR correctly classified 93% ADs and 98% controls (overall accuracy = 95%).

Conclusions: Given its brevity, we recommend the inclusion of a split-half form of the BNT in screening test batteries for the detection of AD. The observed pattern of cognitive impairment is consistent with current models in which semantic memory deficits occur in AD only when the neuropathology extends beyond the entorhinal/hippocampal region to the temporal neocortex.

Objectives: The establishment of a learning disabilities psychiatric service for people living in north Northamptonshire presented the opportunity to measure the clinical effectiveness of epilepsy care provided by learning disabilities psychiatrists.

Method: Baseline and one year outcome health measurements were made on a group of adults with learning disabilities and epilepsy who received learning disabilities psychiatric care (n = 42), and also on a group of adults with learning disabilities and epilepsy who did not receive care from learning disabilities psychiatry -(n = 12). Comparisons were made between baseline and outcome measurements for those who did, compared to those who did not receive psychiatric care. The comparison group was included as conducting a baseline health assessment may itself improve the quality of healthcare by raising awareness of the issue (in a way that is unconnected to care provided by the psychiatrist).

Results: Learning disabilities psychiatric care was found to effect reduced seizure frequency, with a reduced frequency of drug side-effects and reduced frequency of polypharmacy. The type of the person's seizures was more likely to be determined, medical reviews and appropriate blood test monitoring conducted and active interventions made to improve seizure control and to withdraw unnecessary drugs, if the person was receiving learning disabilities psychiatric care. Almost all of these results were highly statistically significant.

Conclusion: It is important that learning disabilities psychiatric care is available to this group, as it has been demonstrated to effect health gain.

Objectives: To describe forensic and clinical characteristics of unfit to plead defendants in Ireland between 1850 and 1995 as well as outcome in terms of length of stay in custody and ultimate disposal of cases. These data are compared with studies from the US and the UK. The White Paper on Mental Health (1995) highlights the need for significant change in the management of mentally ill defendants who come before the courts. The current criteria for the assessment of fitness to plead date from 1836. There has been little previous research on the use of fitness to plead procedures in Ireland which might guide future law reform.

Method: This is a retrospective study of demographic, forensic and clinical data on an almost complete sample of 488 unfit to plead patients admitted to the Central Mental Hospital between 1850 and 1995. A standardised profile was completed on each subject with data drawn from hospital records and entered onto a database for analysis.

Results: The use of the fitness to plead procedures peaked in the period 1910-20, and has fallen into substantial decline since then. Defendants were usually male, with a mean age of 37 years who had been charged with a violent crime. Three quarters of defendants were psychotic on admission. The mean length of detention was 14.3 years and only 4% were ultimately returned for trial.

Conclusions: The decline in the number of fitness to plead findings is probably related to the reluctance of defendants to use the procedure due to the resulting prolonged period of detention. The introduction of a formal judicial review procedure to reassess the appropriateness of detention is urgently required to protect the civil liberties of those found to be unfit to plead.

Objectives: To investigate whether placebo effects may vary in strength, depending on appearance of the medication.

Method: Polish subjects were randomly given different kinds of pills and told that the medicine was produced abroad or in Poland and that it was cheap or very expensive. Measures of different forms of well-being were taken directly after the ‘therapy’.

Results: Subjective ratings were higher for subjects who received big white or small red medicine compared to subjects who received small white or big red pills. The results are discussed in the light of the subject's previous experience with drugs of different kinds.

Conclusion: It was shown that placebo effects do vary in strength, depending on the appearance of the pill.

Objectives: This study set out to explore if there were measurable personality characteristics specific to parents of people with autism.

Method: Parents of 12 people with a DSM-III-R diagnosis of autism presented for the study. Each of the people with autism were matched where possible with a counterpart without autism but with a lifelong disability on parameters of age, sex and IQ level. Parents of the ‘autism’ and ‘non-autism’ groups were then interviewed in detail using four personality assessment instruments. Scores were tabulated for both mothers and fathers in each group and intergroup comparisons were made.

Results: No significant personality profile difference was identifiable between the two parental groups.

Conclusions: Personality traits specific to parents of people with autism are not identifiable in this study thus casting doubt on the validity of personality phenotypes as measurable heritability factors in autism.

Objectives: To examine the operation of a deliberate self-harm service at a large general hospital with reference to standards outlined by the Royal College of Psychiatrists. To examine the characteristics of referrals and to make recommendations for improvements to the service.

Method: Data on referral and assessment characteristics were collected for 96 consecutive referrals over a three month period.

Results: The services achieved the college standards in relation to the time period for assessments. Most referrals were made routinely at a predictable time but assessments were conducted on an ad hoc basis. Only a minority of those referred had a mental illness or complex problems. A significant number of patients were discharged from the A&E department without a psychiatric assessment. Assessors underemphasised the role of previous deliberate self-harm and/or the presence of mental illness in forming a judgment on the risk of suicide. After-care arrangements were predominantly medical (general practitioners or psychiatrists) with little multidisciplinary input.

Conclusions: The deliberate self-harm service at the hospital could be improved by the establishment of a self-harm services planning group to oversee the delivery of the service throughout the hospital and address the deficits identified. Given the number of referrals seen within the service and the fact that deliberate self-harm is only one element of a comprehensive liaison service, consideration should be given to the establishment of a separate multi-disciplinary liaison team. Once again importance is drawn to the need for all assessors to be aware of the risk factors in relation to the future risk of suicide rather than placing undue emphasis on whether the most recent attempt was planned or impulsive in nature.

Objective: Depot antipsychotic medication is often prescribed as maintenance treatment for patients with bipolar affective disorder. In this study we examined the case notes of 14 patients with bipolar disorder who had been prescribed depot antipsychotics. Our aim was to establish the effectiveness of depot medication in this group.

Method: We calculated the total number of hospital admissions, length of hospital stay, and total number of affective episodes for each patient from the onset of their illness to the time of the study. The frequency of affective episodes and hospital admission were compared during periods on or off depot medication.

Results: Treatment with depot antipsychotics was associated with a significant decrease in the number of hospital admissions, overall affective episodes and manic episodes in particular.

Conclusions: Prophylactic treatment with depot antipsychotics may be useful for certain patients with bipolar disorder, in particular those patients who experience frequent manic episodes. Further proof of the efficacy of depot antipsychotics in the prophylaxis of bipolar affective disorder requires the completion of a double-blind prospective trial.

Objectives: Parents often present practising clinicians who see children with chronic fatigue syndrome with printouts from the internet. These are then brought into the discussion about the management and aetiology of this debilitating condition. We set out to systematically study the information on the internet on this subject and to explore the diversity of advice in relation to current research knowledge.

Method: Systematic search by means of the internet browser Netscape Navigator and search engines AltaVista and Yahoo! Advice about levels of rest, exercise, medication, psychological interventions and suggestions about return to school is critically compared with current research evidence.

Results: Thirteen websites were accessed. All have some treatment advice. Six offer conflicting advice about levels of rest, with two suggesting large amounts of rest, two suggesting some rest and two suggesting graded exercise. Nine suggest medications (with a wide variety of pharmacological activities) despite the lack of research evidence showing a significant contribution from medication. Four suggest psychological treatments but some advise that it is unnecessary despite the established evidence in chronic fatigue (and other chronic illnesses) that appropriate psychological treatments are helpful. There are a wide variety of differing diets recommended.

Conclusions: Few websites provide useful management advice. Advice offered is often in conflict. Some of the advice is either contrary to current research evidence or not supported by it. This raises concerns about inaccurate information reaching families who have a child with chronic fatigue syndrome, with potentially damaging consequences. This suggests a need for a debate about the availability and validation of health related information on the internet.

When children under five years of age are assessed and investigated following an accidental injury or self-poisoning, the possibility of psychiatric disorder and indeed suicidal intent is rarely considered. We present a case of repeated self-induced poisonings in a five year old boy, who on psychiatric examination demonstrated serious psychopathology and expressed ambivalence in relation to suicidality. All such presentations should receive consideration as to whether a referral to child psychiatry is indicated. In the training of general practitioners, paediatricians and psychiatrists alike, attention should be given to this area.